tbuckley/cabot-search huggingface dataset:
Abstract 15566: The Impact of Aspirin Use on Progression and Mortality of Abdominal Aortic Aneurysm
Authors: Essa H Hariri, Habib Layoun, Milad Matta, Jean Pierre Iskandar, Robert Burton, Scott J Cameron
Journal: Circulation (2022)

Introduction: Preclinical studies demonstrated a potential role for aspirin (ASA) to slow the progression of abdominal aortic aneurysms (AAA) to rupture. We aim to investigate the association of long-term ASA use with progression and mortality in AAA. Methods: We queried the vascular ultrasound database at Cleveland Clinic for patients who underwent consecutive abdominal vascular ultrasound 2010-2020 if at least two available ultrasounds were conducted, without prior history of aneurysm repair, dissection, or rupture. ASA use was defined as at least one prescription of ASA during the during the follow-up period. The primary outcome was all-cause mortality, assessed by survival analysis with multivariable-adjust Cox regression. The secondary outcome was the mean annualized change of aneurysm diameter, assessed by multivariable-adjusted linear regression. Results: A total of 3,803 patients were included, with an average age of 73, and of which 826 (22%) were female and 2,380 (62.5%) were prescribed ASA (median duration of use ~ 9 years). ASA use was not significantly associated with all-cause mortality irrespective of age, sex and smoking status, except among those with a baseline diameter &gt; 3.5 cm (Figure 1). ASA use was negatively associated with the mean annualized AAA diameter change only in males (0.25 vs 0.38 cm/year, p = 0.002) and in nonsmokers (0.26 vs 0.37 cm/year, p = 0.003). Conclusions: ASA use reduces the expansion of abdominal aortic aneurysms with altering all-cause mortality except in certain high-risk individuals in men and non-smokers. Mechanistic and randomized studies are needed to ascertain the role of ASA in patients with abdominal aortic aneurysms.
Abstract 15435: Evaluating Sex-Disparities in Machine Learning Decision Support Tools for Acute Coronary Syndrome Classification in the Emergency Department
Authors: Zeineb Bouzid, Ziad Faramand, Salah S Al-Zaiti, Ervin Sejdic
Journal: Circulation (2022)

Introduction: Women are less likely than men to be promptly diagnosed with acute coronary syndrome (ACS) and have worse post-ACS outcomes. These diagnostic failures are partially due to ACS findings on surface ECG manifesting differently in women, which may result in unnecessary delays in treatment. To narrow health disparities, we aim to investigate the sex-specific signatures of ACS as they appear on ECGs. Methods: This was a prospective observational cohort study of chest-pain patients evaluated for suspected ACS at 3 UPMC-affiliated tertiary care hospitals. After featurization, all ECG data were separately fed into 7 machine learning classifiers to predict ACS. We examined the results by sex. We also investigated two other methods: (1) building two independent models based respectively on the female and male subgroups and (2) building a model based on the initial total sample supplemented by the patients’ sex. We used Shapley values to explain the decision-making criteria of the models. We report the results for random forest, the best performing classifier. Results: Our sample consisted of 4132 patients (Age 59 ± 16; 47% female; 15% ACS). Machine learning models continue to disproportionately underperform in females across all classifiers evaluated. The sensitivity, specificity and false negative rate in the global model blinded to sex were 82.89%, 76.22% and 17.11% for men, and 67.39%, 74.16% and 32.61% for women (p&lt;0.0001). This statistically significant gap could not be alleviated by building sex-specific models or feeding sex to the input of the model. Indeed, the rate of false negatives in sex-specific models and global models with sex as input were 14.67% and 18.42% for men, and 34.04% and 32.61% for women (p&lt;0.0001). The explainability analysis of the sex-specific models revealed that STT configuration in lateral leads is most informative in women, whereas STT configuration in all leads and particularly in anterolateral leads most informative in men. Conclusions: Machine learning models display crucial sex differences in the ACS signatures on the ECG that consistently put women in a detrimental situation. The alternative methods investigated here are not adequate solutions for this disparity. Thus, further investigations should be conducted.
Abstract 14660: Truncating Variants in <i>MYBPC3</i> Cause Ubiquitin Proteasome System Dysfunction Related to Hypertrophic Cardiomyopathy in Human Induced Pluripotent Stem Cell Model
Authors: Yuta Yamamoto, Victoria N Parikh, Euan A Ashley
Journal: Circulation (2022)

Introduction: Hypertrophic cardiomyopathy (HCM) is the most common inherited monogenic cardiomyopathy. Cardiac myosin binding protein C ( MYBPC3 ) is the most frequently mutated gene in this disease, and most pathogenic variants in MYBPC3 are truncating variants including splice site variants. The ubiquitin proteasome system (UPS), a major intracellular protein degradation system, plays an important role in the heart. Although impairment of UPS is reportedly caused by truncated cMyBP-C, the underlying molecular mechanism causing HCM is largely unknown. Hypothesis: Truncating variants in MYBPC3 lead to impaired UPS activity in human iPS cell-derived cardiomyocytes (hiPSC-CMs) and are associated with HCM phenotypes. Methods: Patient derived iPSC clones were generated from HCM patients with MYBPC3 variants (IVS11-9G&gt;A and IVS27+1G&gt;A). Corrected isogenic control of IVS27+1G&gt;A was generated by base editing. To evaluate UPS activity, we employed ubiquitin fusion degradation reporter, Ub-G76V-GFP, which provides fluorescence readout of UPS activity. BNP expression of hiPSC-CMs were evaluated by antibody labeling and fluorescence-activated cell sorting (FACS). Contractility and Ca 2+ transient were measured from single biopatterned hiPSC-CMs. Results: Both MYBPC3 variant lines exhibited UPS impairment as reflected by increased GFP fluorescence compared to isogenic and healthy controls (Fig. A). IVS27+1G&gt;A showed higher expression of BNP (Fig. B and C). Enhanced contractility and Ca 2+ handling abnormalities were observed in MYBPC3 variant iPSC-CM lines as compared to control (Fig. D and E). Conclusions: Impairment of UPS activity may be associated with a marker of cellular hypertrophy, and contractility and Ca 2+ handling abnormalities in hiPSC-CMs with MYBPC3 truncating variants. These findings support prior reports suggesting that decreased UPS activity contribute to the pathophysiological mechanism of HCM caused by truncating MYBPC3 variants.
Abstract 14682: Gender Disparities in Hypertrophic Cardiomyopathy After Septal Myectomy - Insights From the National Inpatient Sample 2011-2019
Authors: Karla Inestroza, Carlos Matute-Martinez, Ivan Mijares Rojas, Michael Dangl, Ian Ergui, Carlos Vergara-Sanchez, michael Albosta, Rafael J Hernandez, Bertrand Ebner, Jelani Grant, Carlos Alfonso, Rosario Colombo
Journal: Circulation (2022)

Introduction: Data suggests that women with hypertrophic cardiomyopathy (HCM) have worse clinical outcomes than men. However, data from large multi-center studies on gender differences in patients who undergo septal myectomy (SM) is scarce. Methods: The National Inpatient Database was queried from 2011- 2019 for relevant ICD-9 and -10 diagnostic and procedural codes. We compared baseline characteristics and in-hospital outcomes of patients with HCM who underwent SM stratified according to male vs. female gender. A p-value &lt;0.001 was considered statistically significant. Results: We identified 10,805 patients with HCM who underwent SM, of which 55.4% were female. Women were significantly older (60.9 vs. 56.3 years), had more obesity (31% vs. 26.8%), heart failure (44.6% vs. 40%), chronic obstructive pulmonary disease (12.2% vs. 9.2%) and pulmonary hypertension (16.2% vs. 11.5%) (p&lt;0.001 for all) compared to men. Men had more hypertension (75.4% vs. 69.7%), tobacco use (41.5% vs. 34%), alcohol use (3.5% vs. 1.4%), hyperlipidemia (59.3% vs. 55.6%), obstructive sleep apnea (25.9% vs. 15%), coronary artery disease 41% vs. 32%), chronic kidney disease (12.6% vs. 8.7%), atrial fibrillation (46% vs. 40.9%), and atrial flutter (8.5% vs. 4.7%) (p&lt;0.001 for all) compared to women. In-hospital outcomes demonstrate women had higher all-cause mortality (3.3% vs. 1.6%, OR: 2.4 [1.5-4]) and more frequently required intra-aortic balloon pump placement (OR: 6.9 [2.7-19]) compared to men. Men had more intraoperative cardiac complications (OR: 1.4 [1.1-1.6]), pneumothorax (OR: 1.7 [1.25-2.5]), and pericardial complications (OR: 10 [3-33]) (p&lt;0.001 for all) compared to women. Conclusions: In patients with HCM who underwent SM, women had higher all-cause mortality despite having less comorbidities than men. These highlights potential gender differences in outcomes in patients referred for SM. Whether biases exist in referral patterns needs to be further elucidated.
Abstract 235: Post-shock Asystole And Inappropriate Shocks In Patients Dying Out-of-hospital While Wearing A Defibrillator
Authors: Justin M Berger, Jay Sengupta, Susan A Casey, Alan J Bank, Scott W Sharkey, Robert Hauser
Journal: Circulation (2022)

Background: The LifeVest wearable defibrillator (LWD) is prescribed for patients who are at risk for sudden cardiac death. However, it does not provide backup pacing for post-shock asystole (PS-A) or post-shock bradyarrhythmia (PS-B;&lt;50 bpm). We sought to determine if this limitation may have impacted outcomes in patients treated with the LWD who died out-of-hospital (OOH). Also, we assessed the incidence and clinical consequences of inappropriate shocks (IAS) in these patients. Methods: The U.S. Food and Drug Administration's Manufacturers and User Facility Device Experience (MAUDE) database was queried for the manufacturer's descriptions of events and stored ECG findings of patients who died OOH while wearing the LifeVest. Excluded were LWD patients who did not receive a LWD shock during the terminal event. Results: From January 2017-March 2022, 543 patients died OOH and received at least one LWD shock (avg 3.9±4.5SD; range 1-34). Of these, 120 (22.1%) had PS-A alone, 26 (4.8%) had PS-B alone, and 85 (15.5%) had both PS-A and PS-B. PS-A first occurred after shock #1 (n=127; 62.0%); shock #2 (n=29; 14.1%); shock #3 (n=18; 8.8%), and shocks #4 to #18 (n=31;15.1%). For the 205 (37.8%) patients who had PS-A with or without PS-B, the rhythms appropriately shocked were ventricular fibrillation (VF; n=121; 59.0%) and ventricular tachycardia (VT; n=63; 30.7%). Of the 184 patients whose initial rhythm was VF/VT, 118 (64.1%) died in asystole after the first and only shock, 40 (21.7%) died in asystole after the second (n=23) or third shock (n=17), and 26 (14.1%) died in asystole after the fourth to eighteenth shock. Twenty-one patients died when asystole occurred after they received IAS for atrial fibrillation (n= 3), supraventricular tachycardia (n= 4), and sinus (n=4) or idioventricular rhythm (n=10). Overall, 70.3% (382/543) of patients received one or more IAS (avg 2.7±2.8SD; range 1-26). Conclusion: Post-shock asystole and post-shock bradycardia are common in patients who die after receiving appropriate LWD shocks. Most patients received one or more IAS, and some were lethal. Whether back-up pacing and better rhythm and noise discrimination could improve outcomes warrants investigation.
Abstract 14825: Utilizing a Novel Horizontal Approach for Implantable Loop Recorders
Authors: Maryam Kazmi, Rohan Viswanathan, Kandarp Suthar, Kajol Shah, Jorge Naranjo, Saahil Jumkhawala, Majd Hemam, Perry Wengrofsky, Emad Aziz
Journal: Circulation (2022)

Introduction: Implantable Loop Recorders (ILR) are used in detecting and monitoring arrhythmias. These subcutaneous devices remain in place for years for continuous cardiac monitoring. There have been few studies on how best to position an ILR for maximum accuracy and comfort. Currently, manufacturers recommend insertion of the ILR at a 45-degree angle from the sternum at the 4th intercostal space and a minimum R wave amplitude of 0.2mV for adequate sensing. We adopted the technique of implanting all ILRs horizontally between the 4th and 5th ribs and examined patient outcomes. Methods: Data was obtained through chart review of 288 patients who received a horizontally placed ILR from 2019 to 2021. Patient’s age, sex, BMI, indication for ILR, ILR manufacturer, episodes of artifact and complications were collected. The R wave magnitude (mV) immediately succeeding implantation was recorded from the procedure note. Results: Of our patients, 91% received a Medtronic ILR, 6% had a Boston Scientific ILR and 3% had a Biotronik ILR. The mean age was 60 ± 14 years, with 51% of patients being male. Within the sample, 27% had a BMI less than 25 kg/m 2 , 33% were overweight, and 40% were obese. Approximately 271 patients had a documented R wave amplitude at implantation, with the average being 0.44 mV ± 0.41 (95% CI 0.39 to 0.48). Of 240 patients with follow-up, 8% had an arrhythmia recorded that was found to be a false positive episode. There were no major complications. Conclusions: Using the horizontal approach, we obtained adequate sensing based on average R wave amplitude. We had very few false positive arrhythmias, as only 8% of our patients were noted to have a false positive reading versus 25% reported in other studies. This approach minimizes involvement of breast tissue and thus reduces risk of peri-procedural bleeding and ILR migration and increases patient comfort. The outcomes of our population indicate that this is a viable approach and may be superior to standard.
Abstract 14690: Deep Learning Assisted Target Lesion Analysis Using Advanced Border Detection Algorithm of Intravascular Ultrasound
Authors: Sang Wook Kim, Kyung Teak Park, Jun Hwan Jo, Moonki Jung, Haegeun Song, Seung Yong Shin, Sangyeub Lee, Nam Ki Kim, KI-WOON KANG, Sungsoo CHO, Kyung Min Byeon, Ho Yeon Won, Ounjung Cho, Young-Hoon Jeong, Hyue Mee Kim, Wang Soo Lee, Kwang Je Lee, Tae Ho Kim, Chee Jeon Kim, Tae Hoon Ahn
Journal: Circulation (2022)

The vessel-plaque interface detection and lesion length of coronary artery disease are still challenging using the deep learning with intravascular ultrasound (IVUS). We used AI-based image segmentation technology to develop a deep learning model for classifying frames with IVUS-derived target lesion. Methods. A total of 3,782 target lesion frames from 28 acute coronary syndrome(ACS) patients were randomized into training and test sets in a 2:1 ratio. The training algorithm was based on the measurement of the core lab. A segmentation model using non-local blocks was used to increase the similarity between pixels of the same class in a U-Net-based model. The edge detection was performed on the region of interest, and the detected edge was used as an aid in deriving the final segmentation result. And the morphological guided measurements were used to provide the information about the vessel area, lumen area, plaque burden and lesion length. Quantitative evaluation was conducted on four scales: Jaccard Measure (JM), Dice Similarity Coefficient (DSC), Hausdorff Distance (HD), and Percentage of Area Difference (PAD). And we compared the diagnostic accuracy to detect the vessel-plaque interface of the target lesion. Results. In the training sample (1,256 IVUS frames of target lesion), and the test samples (1,072 IVUS frames of target lesion) were used for the proposed model. The external elastic membrane area (EEM), lumen area, plaque area and thrombus were assessed with the proposed algorithm. The measurement of EEM was DSC 0.99, JM 0.98, HD 0.06, and PAD 0.01. And the lumen also shows excellent performance with DSC 0.98, JM 0.97, HD 0.08, and PAD 0.01. In addition, the proposed model was compared with ground-truth for Thrombus, and showed high values of 0.88 for DSC, 0.83 for JM, 0.21 for HD, and 0.09 for PAD. Conclusion. An advanced algorithm can accurately detect the vessel-plaque interface and estimated stent length of coronary artery disease with high reproducibility. F
Abstract 14539: Interhospital Differences in the Use of Critical Care Therapies in Coronary Intensive Care Units and Its Association With In-Hospital Mortality: Insights From the Critical Care Cardiology Trials Network
Authors: Sarah J Donnelly, Jason N Katz, wayne J tymchak, Erin A Bohula, Jianping Guo, David Berg, David Morrow, Sean Van Diepen
Journal: Circulation (2022)

Background: Previous studies have shown wide interhospital variation in cardiovascular intensive care unit (CICU) admission practices and use of critical care restricted therapies and monitoring (CCRx), but little is known about practice differences among tertiary and academic CICUs. Methods: The Critical Care Cardiology Trials Network (CCCTN) is a multicenter registry of tertiary and academic CICUs in the USA and Canada that contributed consecutive patient data in annual 2-month periods from 2017 to 2021. The analysis included 13,318 admissions across 28 sites and compared interhospital variability in CCRx and its association with in-hospital survival. Results: CCRx was provided to 61.4% (interhospital range 28.3 - 86.7%) of CICU patients. Admissions to CICUs in the highest tertile of CCRx utilization, compared with the lower tertile, had a greater burden of comorbidities; less frequently admitted patients with ACS (18.7% vs 35.8%); more frequently admitted cardiac arrest (4.9% vs 2.6%) or cardiogenic shock (5.8% vs 1.9%); and had higher median admission Sequential Organ Failure Assessment (SOFA) scores (5.0 vs 2.0), lactate (1.9 vs 1.8 mmol/L), and creatinine (1.3 vs 1.1 mg/dL) levels. Unadjusted in-hospital mortality varied widely between CICUs (median 12.6%; range 4.0-23.5%; p&lt;0.001). After adjustment for patient differences, the correlation between CICU provision of CCRx and in-hospital mortality was weak (r=0.287, p&lt;0.001). Conclusions: In a large registry of tertiary and academic CICUs, there was large interhospital variability in the provision of CCRx. The weak adjusted correlation with in-hospital mortality suggests that standardized CICU admission criteria could reduce disparities in admission practices and improve health-resource allocation. Figure 1: Unadjusted correlation between individual CICU utilization of critical care restricted therapies and in-hospital all-cause mortality
Abstract 14578: Dapagliflozin Attenuates Aorta Smooth Muscle Aging and Atherosclerosis <i>via</i> Inhibiting the PPARα Pathway
Authors: Weiwei Zhang, Dong Han, Yabin Wang, Yan Ma, Lei Tian, Feng Cao
Journal: Circulation (2022)

Objective: SGLT2 inhibitors reduce cardiovascular risks in ASCVD (Atherosclerotic cardiovascular disease) patients independently of glycemic control while the possible mechanisms remain unclear. Smooth muscle senescence is one of the major risk factors exacerbating AS (atherosclerosis). We hypothesized that dapagliflozin inhibits smooth muscle senescence and results in the reducing AS plaque area. Methods &amp; Results: After treatment with dapagliflozin (10umol/L 12h), the cellular senescence and oxidative stress were decreased as measured by expression of P53 (-23%), P21 (-16%) and ROS production (-19%), (all p&lt;0.05) in VSMC induced by the palmitic acid (PA). The trend was also revealed in the AS mouse model. The X-Gal positive VSMC (-20%, p&lt;0.05) as well as the area of SA-β-Gal positive zone (-11%, p&lt;0.05) were significantly reduced after dapagliflozin (0.1mg/kg/day) treatment for 12w. Further analysis of the atherosclerotic lesions revealed a reduction of AS plaque protrusion into the vessel lumen (-21%) and reduced the size of lipid necrotic area (-32%), the thickness of fiber cap (-15%), (all p&lt;0.05), which were indications of instable atherosclerotic plaques. The effects of dapagliflozin on mice aorta were assessed by unbiased transcriptomic analyses. GO and KEGG analysis indicated alterations of the fatty acid metabolic, fatty acid oxidation and PPARα pathway after dapagliflozin treatment. Abnormal activation of PPARα in AS aorta and PA-treated VSMC, were inhibited by dapagliflozin (-18%, -35%, both p&lt;0.05). The protection effects of dapagliflozin on VSMC could be abolished by the PPARα agonist. Conclusions: Dapagliflozin exerts beneficial protecting effects on smooth muscle from senescence and ameliorating lipotoxicity in atherosclerosis by inhibiting the PPARα pathway. These findings suggest a novel mechanistic basis for SGLT2 inhibitor attenuating atherosclerosis mediated by PPARα, linking fatty acid oxidation and cellular senescence.
Abstract 14680: Outcomes of Coronary Artery Bypass Graft in Patients With Atrial Fibrillation - A Study From National Inpatient Database 2016-2019
Authors: Govinda Adhikari, Nischit Baral, Amith Reddy Seri, Soumya Kambalapalli, Calvin Ghimire, Neej Patel, Arvind Kunadi
Journal: Circulation (2022)

Introduction: Atrial fibrillation (AF) is a common arrhythmia after Coronary artery bypass graft (CABG). There is a paucity of data on the outcomes of CABG either On-pump CABG (ONCABG) or Off-pump CABG (OFCABG) in patients with underlying AF. Methods: We queried the National Inpatient Sample (NIS) from 2016-2019 to identify adult patients who underwent CABG (On and Off-pump) using ICD 10 codes. Patients were divided into two groups based on history of AF. Primary outcomes of interest were in-hospital mortality and mean length of stay. Other covariates of interest included sex, age, race, insurance, income quartile by zip code, comorbidities, hospital location, and size. We used the Charlson Comorbidity Index (CCI) categories to account for comorbidities. We ran multivariate regression models to investigate the possible association. Results: There were 100,715 unweighted index hospitalizations identified for ONCABG and 25,956 for OFCABG. Patients were predominantly male and white race with a mean age of 65.7 years. A total of 34,333 (34.1%) patients had underlying AF in ONCABG group and 8369 (32.24%) in the OFCABG group. Multivariate regression analysis showed that in ONCABG, AF gorup had significantly higher odds of in-hospital mortality (aOR: 1.22; 95% CI: 1.10, 1.36; p = &lt;0.001) compared to those without AF. Similarly, in OFCABG group, AF group had significantly higher odds of in-hospital mortality (aOR: 1.26; 95% CI: 1.04, 1.52; p = 0.019) compared to those without AF after controlling for the covariates of interest and comorbidities. The mean LOS was higher in the AF group in both ONCABG (10.6 vs 8.59 days, p&lt;0.001) and OFCABG (10.78 vs 8.77 days, p&lt;0.001). The number of ONCABG performed each year increased from 24,761 in 2016 to 25,683 in 2019, however, the number of OFCABG decreased from 7008 in 2016 to 6179 in 2019. Conclusions: AF was associated with increased in-hospital mortality and mean LOS among the patients who underwent CABG. The number of ONCABG performed each year increased whereas the number for OFCABG decreased.